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We do not yet have approval for IN routes (lengthy pharmacy committee approval
process) but I have had success with carefully selecting a population limited to
diaper age using rectal versed 0.7 to 1 mg/kg for quick procedures--seems to be
more reliably a euphoric rather than the disinhibiting response sometimes seen
with IV benzos, making for a very happy silly child who can easily be distracted
from annoying interventions, usually without actual sedation and therefore with
very low risk of airway problems. My favorite was a three year old boy who was
unhappy with us until 5 minutes after his dose when he turned to me and said, "I
am so pleased to meet you!"  I don't use it in children who have moved on into
the toilet training age and are no longer in diapers.  Pat O'Malley

-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]] On Behalf Of paul frandsen
Sent: Thursday, July 09, 2009 4:38 PM
To: [log in to unmask]
Subject: Re: intranasal versed or fentanyl

Thank you all for your responses.  From what I can tell, most of you are using
0.25 mg/kg in your IN versed dosing.  I have found reports in retrospective
trials of procedural sedation/anxiolysis of doses from 0.25 mg/kg to 0.8 mg/kg.
The largest max dose found was 10 mg total.  Even in these higher doses it
seemed the safety profile was outstanding.  

Do any of you have experience with dosing on the higher end?  Do you personally
have a max dose you use by policy or practice?  In a busy community ED where
throughput is stressed, it seems that the 20 minutes or more improvement in the
decreased stay surrounding the procedure (not including the time it takes for IV
administration/nursing resources) and the decreased trauma to parents minus the
IV it seems that versed is a viable alternative.  

Thank you again for all your thoughts.

Paul Frandsen, MD 

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